This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Monday, 26 July 2010

This Makes Me Sick

Today I learned that my ward is gaining more beds. We will be taking more acute patients and having higher throughput. After a letter writing campaign initiated by myself, the ward sister and another senior staff nurse a letter was received by management. "We are sorry to hear of your staffing issues. You will be getting extra staff in the form of .5 of an auxillary. By our calculations this will bring you to a full complement of staff".

What. The. Fuck.

We are losing two HCA's. This leaves us with two HCA's in total on the duty roster. The other care assistants are all inexperienced apprentices and auxillaries. I know of 4 HCA's who want jobs on my ward. They have been turned away.

Management has taken the only room on the ward that we have for lunch breaks and handover and are turning it into a patient sideroom. This leaves us cramped into a very small space for handover.

The day staff had to sit on the floor while the night nurse who had been on duty for over 14 hours had to sit precariously on a wobbly ledge thing for the change of shift handover. It takes a half an hour at least to handover. Talk about uncomfortable. If we handover at the nurse's station patients will overhear us and report us for "breaching their privacy".

Breaks are impossible. The staff nurse really isn't in a position to leave the ward for a 15 minute walk to the canteen due to short staffing. She won't have another nurse to watch her patients. She will not be able to eat in the cramped handover room from hell unless she sits on the floor and wants to get interrupted every 2 seconds. That means the staff nurse's only option is to eat at the nurse's station thus inviting a whole bunch of smart ass comments from visitors and doctors who do not realise that she is only taking 10 minutes to eat in a 12 hour shift. Nor do they realise that she has no where to go to eat.

Get the f*** out of there! You couldn't pay me enough to work under the conditions your describe. The top-heavy management has already proven that they do not respect you and are completely out of touch with reality. It will only continue to get worse.

I'm due to start my nursing training in September and I really am wondering if I'm doing the right thing already :S You all really need to take a stand, breaks are not optional, it surely can't go on, management need to take responsibility.

The only way things will change is if nurses get together, stop whinging and be proactive. We need a union that will stand with us, not against us. We need to follow the examples of the US and Oz and take industrial action. Prior to this we need to get a petition going that asks for a review of SAFE staffing levels. Its all very well saying that we need to be cost effective-however safe staffing levels would mean no pressure sores, falls, malnourished patients etc etc...problem is NO ONE WANTS TO PAY as its only old, vulnerable patients. We forget that we will all be old at some point. If I was admitted to ED or an admissions unit I would be terrified. Less staff on the wards means that more acutely ill patients deteriorate and end up on the ICU. Just today our CCOT staff (nurses and docs) have wanted to admit 4 patients from the hospital and we currently have- you guessed it- NO BEDS.

Had thousands of signatures from across the UK.Whitehall responded with some bullshit like "staffing levels are best managed at local trusts".

I am in favour of a walk out. So are my colleagues. I say this knowing it may kill a lot of people. It's not just the stuff I am whinging about on here. It is everything.

Last week when I came on duty the lone RN for 19 patients told me her patient died because he needed one to one monitoring. She had two such patients and had to choose which one to stay with pretty much sealing the death warrant for the other guy. Shje called for more staff and they sent her a 17 year old untrained auxillary who was sat on the nurse's station on her mobile. Not that a teenager would have been of any use anyway.

Oh it's already started. There were 2 RN's both working this AM. No chance to leave the ward for a quick bite to eat so the one RN took a few bites out of a sandwich while she was looking up some bloods at the Nurse's Station. She was on a 14 hour shift and all she did was grab a few bites of a sandwich while she was working rather than endanger the patients by leaving the ward to take a proper break.

"You are very unprofessional to sit there eating....go to your break room!!!" booms a consultant as he walks by.

And the trust will still deduct her for 2 half an hour meal breaks that she will not take.

You couldn't make it up..

Can't wait to see how we get dicked by the GP's when they get to decide how much we are paid.

Imagine all the GP's out there that belive that have patients crying in their office about poor care....and who believe the "too posh to wash, to clever to care" bullshit.

I foresee many RNs leaving the UK unless things drastically improve. Now that all our newly qualifieds will have degrees, they will be on level pegging with the US and the rest of the world. This is what makes me laugh...joe public thinks that all the little filipino nurses are here because they want to work in the UK...no, they are here because they want to work in the US and we are a good stepping stone whilst waiting for their work visas. Plus they are almost all degree-educated, so strike two. I stand by my predictions that given another decade of this, the only place you will find hands-on RNs will be ED and critical care. This will allow trusts to save a packet by having untrained staff on acute wards with minimal supervision...woe betide any RN who takes a sisters post on these wards as they will be hung out to dry.

Ridiculous bullshit and Im tired of hearing that these people dont get fed 'cos nurses are lazy - trained nurses are v. rarely lazy people I find ....and nurses are all too willing to get their work done and provide excellent care - but its a simple matter of math - fewer nurses + high # of high acuity patients = lower standard of care - also I read they are going to be closing nursing homes - so those patients will be ending up onn acute wards. Brilliant...

Our ward sister is on her knees. They are asked to do the impossible. She puts in a 30 hour workweek at home on top of a 40 hour week working shifts as the lone RN with nothing but auxillaries to help.

Dino you are also right about the Philipino nurses.

They are all educated to the US degree-BSN standard. In comparing notes with a philipino colleague I learned that we even used the same textbooks at school. You know I did my training in the US.

And they are only here to improve their English to get to the United States.

Anonymous they are always on us about delayed discharges but there is not place to send these people to and you are right they are going to close nursing homes.

The public depicts the nurses as lazy when they don't get what they want. They want me to come right now to get their mother a commode...but I have to finish what I am doing on the computer---Mr. Jones is about to crash and I am ordering the drugs that the Registrar has just ordered for him. If I get the commode and then go back to the computer Mr. Jones is dead.

The public sees this as "lazy Nurse sat on facebook while granny was suffering"

Goddamn daily mail has my IP address banned or something. Can anyone post there? I know it is a waste of time and energy trying to wake up all those stupid people who think that Nurses brought in the auxilliaries because they are "too posh to wash".

And the ones who think that University training pulled student nurses off the wards are even more stupid.

But it might be worth a try to post a link to this blog there or say-google militant medical nurse.

Anne i've tried leaving your blog details on the Daily Fail site soooo many times...and they won't allow it. Why would they? The truth contradicts their sensationalist bullshit. It awful, I cannot believe that they spew this evil.

the year is 2110 and capgrass`s great great grandchildren are off to london on the methane gas train to visit the Nurse Anne`s museaum which is housed next to a great london hospital. (which has now been turned into an aquarium as hospitals dont exist anymore as they became too expensive...........its all done on line now. they watch the realisitic wax-works and listen to the smells and sounds of a 2010 ward and then they move on to see a model of Dino nurse and this ancient looking antique called a Servo-i. and they refuse to enter the really scary section called "the long term wean" but they did agree to experience the feeling of being buried alive by paperwork. Afterwards their Father took them to a cafe to cheer them up and they all enjoyed a plate of chips.

Tee Hee. Lets hope they also included the x-rated room where you could enjoy the experience of being shafted by the government. Have just come back from a scary meeting where they are considering opening "weaning" beds on one of our acute medical wards. They want ICU to staff it initially...on a voluntary basis (bribed by a Band 6 supplement) and to train the permanent staff. The physios have already voiced their concerns...increased call-outs for them out-of-hours as the ward staff will not cope. I have added my concerns about the risks to patients and the increased load on ICU (we will not get additional staff during the start-up phase). Managers poo poo-ed this as they think it will save money by freeing up ICU beds. I have tried to point out that long term wean patients are often the trickiest and the ones that even with 1-to-1 nursing by expreienced nurses can still deteriorate rapidly. Our chief consultant left after half an hour saying it will be over his dead body. It will certainly be over someones dead body if it goes ahead. ICU has the luxury of experience plus gasmen on 24/7. Medical units will normally have an F1 or F2. I can hardly wait for the first panicked call as someone has plugged off. Cue me running along a corridor dragging hi-flow/CPAP/BiPAP/Drager (none of which will be available outside the ICU) whilst trying to fast bleep an ICU SpR to meet me.

I physically cannot read any more of those stupid comments on the Daily Mail link you have done!! Its is making me feel sick with rage - these idiots are so brainwashed and one track minded for nurse-bashing!

If there is one thing in this life that the Daily Mail has taught me it's -DO NOT BELIEVE ALL YOU READ IN THE PAPER!

People read this SHIT and believe it! Its disgusting! I have sent your website link twice Anne, along with a link to reputable evidence into WHY nursing care suffers - ie : Nurse Patient ratio's, burnout, underfunding etc etc. It balances the story excellently - in a manner these idiots need to learn.

So the management won and capgrass was sent to do an agency shift (£32 per hour on a sunday) on a medical ward: she was allocated 4 tracheotomy "weaning patients" and a 5th patient "self caring" who wanted to go home but needed Capgrass to organise TTOs, dressing, teach how to inject fragmin, OPA, Transport, and fill in menu for lunch. Ah ha thought Capgrass........how shall i cope? Well i know! i`ll cut corners! its the only way! of course i`ll check my suction is working ect but I am not going to hoist anyone out of bed. Forget the bristol stool chart; in fact I have put it in the box of chocolate 5th patient has given me. My F1 thinks it is a chocolate selection display. Forget my saving lives; if there is an I.v. cannula............good: so what if it is 10 days old. drugs? well i really havent got the time so i`ll just sign for them anyway but not give them. anyhow at least i have done all the obs! now: time to do an ABG.......great! the patients have arterial lines, not transduced but SO WHAT! so off Capgrass trots to ICU with a blood gas. meanwhile the trachy patient in bed 2 on Cpap becomes discontected. No one notices (its a whisper flow: no alarm system0 and Capgrass is busy ringing the door bell for ICU................. anyhow Dino isnt around cos she is visiting the donut of death (CT scanner) with an ICU patient. thus the disconection goes on and on and on, and meanwhile Capgrass has decided to go to the new Costa coffee house to get a latte as this shift looks likes its going to be busy....................as Dino wants to bring the CT patient to the medical ward to as her manager thinks it will save moneeeeeee

Oh how we laughed. Just as an aside, Uni lecturer- what are staffing levels like in your neck of the woods? Do RNs on acute wards have more than 6 patients each? More than 10? If its closer to the later, do you think that this is a safe environment for your students to be learning in? I have alot of involvement with our school of nursing and am always trying to get them to give me a straight answer on this one. Many of the students we see on the ICU tell stories of being on duty on general wards (medical and surgical) with 2 RNs and maybe 1 HCA for 28 elderly, acutely ill patients. As for the admissions units- it would terrify me to have responsibility for a student as well as all those patients. This is often where fairly junior students are dumped. The school can only threaten to remove the students but then, uh oh, where else to put them? So they do nothing. Student numbers have almost doubled in 6 years- bums on seats=cash. Having worked as a lecturer myself ( science not nursing) I know how difficult it is to teach labs with over 100 students crammed into space designed for 50. Difference being I was not sending these students out into an unsafe workplace as part of their "education". You seem to be missing the point somewhat- we are not "having a go" at non-degree educated nurses. I trained in the late 70s myself so do not have a nursing degree. Instead when I left nursing in the 90s I did a science degree (whilst bringing up my kids) and then went back to nursing after finding that I missed it and lecturing was not for me. The "nurses" that I have no respect for are the ones who are now senior managers but have NEVER set foot on a ward since the 90s. There are many of them. I wish that the NMC would rule that to keep your PIN you need to do some ward-based nursing every year. When I worked in the US many of the nursing managers HAD to keep their skills up as when the nurses worked to rule, they were the ones who had to come onto the floor and work. Medics have to stay clinically active so I think we should have to as well. Any thoughts?

All the blogs I read about endemic failures within UK industy or the Public Sector, all have one common theme - fcuking useless mangement, and the further up you go, the more uselss the b'stards get.

I look forward 9sarcasm btw) to the cuts, as we know what will happen - umpteen layers of shiny arse management will be left alone, ditto the legions of support staff that the uselss box tickers seem to be able to get (no matter how tight the budget), whislt the coal face staff get the boot - all so the iron rice bowls of the bureaucracy are saved.

Shit, your staffing levels are appalling - even in our shit hole of a hospital they're better than that - and that's still not enough.

"There have been complaints for years about nurses not bothering to help frail and elderly people eat their meals, often placing food out of their reach and throwing it away uneaten."

This sums it all up really - nursing staff are progressively being replaced by HCAs and yet the government and public fail to recognise the difference between trained nurses and teenagers fresh of the street.

To me HCAs are almost invisible because, except for a few notable exceptions, they can't be trusted (and are unwilling anyway) to take responsibility for anything so I can't even pass on messages to them or ask them questions about my patients, and they can't actually do anything on the ward that I might want done. Which means I'm constantly harrassing the nurses for stuff (even drugs I could give myself but I'm not allowed because I don't have a key to the drug cupboard).

"This sums it all up really - nursing staff are progressively being replaced by HCAs and yet the government and public fail to recognise the difference between trained nurses and teenagers fresh of the street"

Quote of the month. When it gets to the point that there are no Nurses at all on the wards and patients are dying because they are not getting drugs, getting overloaded with IVI's etc etc the public will still be saying that "the whole problem was when they put nurse training into higher education"

Anyone remember Labour coming into power along with the "THINGS WILL ONLY GET BETTER" anthem? Well, it didn't. Now the tories will complete thatchers legacy and privatise whats left. Its started already...we have a shiny new body scanner parked outside ED thats leased from a US company. Staffing levels are down (as always) but ICU used to be seen as an area that should be staffed properly...no longer the case. Yesterday we had 14 proper ICU patients (most ventilated and several on renal replacement and cardiac catheters) and 10 staff plus me...so already not an ICU. Still had to send 2 staff to the surgical unit as otherwise they would have to cancel ELECTIVE surgeries. Never mind that we will now be blamed for 2 breaches in ED as I refused to ship 2 patients out to our new halfway house (mixed experiemental "monitored" ward which means that all patients have monitors attached but staffing is still one nurse to 8 patients)the reason? They were long term trache weans and as I have said until I am blue in the face , these are the most dangerous group to skimp on. No doubt I will be held to account next week :0(

As a newly qualified itching to start work as a staff nurse there are no band 5 jobs at my trust, so I am working bank as a HCA in the mean time to keep my foot in the door.

Assistant Practitioners (APs) are very much in vogue at my hospital. After all, they can do EVERYTHING a nurse does except administer medication. I have yet to fathom what they actually do that is beyond the remit of a HCA.

Don't get me wrong, some of the experienced HCAs are fantastic, but others are terrible.

And why can they never complete fluid charts? The poor RN subsequently gets bollocked by the medical team on the ward round because they have no information regarding patient's hydration. Crazy!

Well of the docs keep up their bollocking and screaming they will soon find the wards staffed with only auxillaries and the doctors will have to take off their own orders, give their own drugs, organise their patients on discharges, and monitor their own patients. Wait until they see how complicated all that is and how long it takes.

If the hospitals don't want RN's and the doctors just want to bollock us for stuff we cannot control why don't we just walk out and leave the auxilliaries and the juniors doctors to get on with it?

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.